(Caption)

APPLICATION FOR EXPUNGEMENT OF POLICE RECORD

1. On or about _______ , _______ (Date), I was arrested, detained, or confined by an officer of the _______ (law enforcement agency)

at _______ , Maryland as a result of the following incident (law enforcement agency) at _______ , Maryland as a result of the following incident__________________

2. On or about _______, _______ (Date), I was released without having been charged with a crime.

3. On or about _______, _______ (Date), I requested the law enforcement agency to expunge my police record pertaining to the incident.

4. The above named law enforcement agency (check appropriate box):

[] issued the attached Notice of Denial of Request for Expungement.

[] failed to notify me of any action taken within 60 days after receipt of my Notice and Request for Expungement.

WHEREFORE, I request the Court to enter an Order of Expungement of all police records pertaining to my arrest, detention, or confinement, and all court records of these proceedings.

I solemnly affirm under the penalties of perjury that the contents of this application are true to the best of my knowledge, information, and belief and that the arrest to which this application related was not made for any nonincarcerable violation of the Vehicle Laws of the State of Maryland or any traffic law, ordinance, or regulation.